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Alaska rates for HCPCS J0390

Injection, chloroquine HCl, up to 250 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.69 / $27.69 / $97.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.20 / $27.97 / $27.97
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.72 / $31.08 / $41.80